While work and life have been intertwined for years, there is less distinction between them now than ever before. Because of the pandemic, working from home at least part of the week has become the norm. From writing emails while lounging on the living room sofa to folding laundry while in a meeting, the way we work has drastically changed over the past few years. Employees are now wondering how to best integrate work and life, and how work-life integration can help prevent burnout.

The rise and effect of remote work

Because of the rise in remote work, the line between employees’ personal lives and work lives has become blurred. Employees and their managers are starting to value work-life integration over work-life balance due to this blurred line.

A healthy balance between work and life is paramount as employees struggle with the shifting landscape of the workforce, mental health challenges worsened by the pandemic and overall burnout. According to Zippia, 89% of workers have experienced burnout within the last year. Work-life integration offers a potential solution to employee burnout, which can help improve a worker’s mental state as well.

What is work-life integration?

The Society for Human Resource Management defines work-life integration as “a holistic approach that seeks to blend personal and professional needs.” Instead of focusing on finding the perfect balance between personal and work life, work-life integration seeks to blend the two.

Employees’ lives and workloads are constantly changing, which is why work-life integration strives to be flexible. Workday schedules and personal schedules are integrated depending on each day, so no one day looks the same as the previous.

Work-life integration vs. work-life balance:

While the overall goal of both work-life integration and work-life balance is to find balance between the workday and the personal life of an employee, the approach to each concept is different.

Work-life balance treats work and personal life as two distinct things. Employees strive to accomplish as much as they can within working hours to be able to enjoy their personal life before and after the workday. Because of the continued shifting landscape of the workforce and the increase in work-from-home policies, work-life balance might not be the best approach for finding balance.

Work-life balance can seem unrealistic as employees increasingly have to handle personal issues during the workday: answering a phone call from their family member, taking the dog for a quick walk around the block or heading out a little early for a dentist appointment.

Work-life integration expands on the concepts created by work-life balance. While work-life balance separates work from life, work-life integration combines the two. Employees strive to find harmony between their lives and their work responsibilities.

Employees decide when to use their time for work tasks versus personal tasks. Gartner research found that 43% of workers said that having flexible working hours increased their productivity. While work-life balance fades out, work-life integration seems to be the direction the workforce is moving toward.

How to implement work-life integration as a manager:

• Gain insight from employees – Conduct surveys to determine what current work-life integration strategies are working and which could be developed.
• Allow employees to pick their most productive hours – Determining when employees feel the most productive can allow managers to understand which days should be work-in-office days and which days they should allow employees to work from home.
• Create and implement a plan – Implementing a plan ensures that work-life integration is a priority. A work-life integration strategy could include simple things such as providing childcare services and a walking club during lunch breaks, or something more complex such as continued learning opportunities and a four-day workweek.

How to implement work-life integration as an employee:

• Create and implement a plan – Learning to be flexible can be difficult for employees who have been used to strict work schedules for years. Allow time for this change to become rooted into daily life. Creating a personal plan can be helpful; create a checklist of work to-dos and personal to-dos for the day and tackle each task when time allows.
• Find support from family and employer – Ensuring that family and managers are aware of the flexibility of work-life integration is important. Having support from both family members and co-workers can ensure that you don’t neglect one side of work-life integration while putting your entire focus into the other side. Allow them to hold you accountable.
• Don’t aim for perfection – Constantly working leads to burnout. Allow yourself moments to spend doing personal tasks without feeling guilty for taking a break from work. There is no perfect amount of time to spend on work, so allow yourself time to decompress before tackling the next obstacle.

Work-life integration is possible

While some people might prefer to completely separate work from personal life, developing a work-life integration mindset offers employees a relatively new way to structure their work and home life. As lines continue to be blurred between home and work, work-life integration becomes the future structure of the workplace.

Telemedicine allows healthcare professionals to connect with patients remotely. Advancements in electronic information and telecommunication technologies have fostered the rapid adoption of telemedicine in the past decade. According to Doctor.com’s report on healthcare trends in 2020, telemedicine adoption increased by 33% over the previous year, and telemedicine funding is expected to reach $185.6 billion by 2026.

COVID-19 has been a major catalyst for telemedicine adoption. In response to lockdowns and closures, clinicians adjusted their practices to offer treatment in a pandemic-safe manner, and many implemented telemedicine technology. This resulted in a sizable population of patients becoming familiar with telemedicine. In fact, Medical Economics found that 83% of patients expect to use telemedicine after the pandemic resolves.

However, for dental practices, telemedicine adoption continues to lag behind other medical fields. What is the cause of this?

In this article, we offer an overview of teledentistry, telemedicine for dentists. We discuss the primary benefits of teledentistry, and cover some of the pain points inhibiting its growth.

What is Teledentistry?

Teledentistry is the use of telecommunication technology to allow long-distance dental care, consultation, education, and public awareness. In general, there are two types of teledentistry.

Synchronous teledentistry refers to the real-time interaction between patient and dentist through the use of video conferencing tools (i.e., Evaluating patients through a videoconferencing tool, like Zoom).

Asynchronous teledentistry refers to the non-direct interaction between patient and dentist through the transfer of recorded health information (i.e., Sharing videos and radiographs through a HIPAA-compliant messaging service).

Teledentistry Benefits

Teledentistry offers various benefits for dental practices and patients. Some of the most important benefits are showcased below.

Increased safety

Teledentistry allows dentists to interact with patients in different physical locations. Teledentistry has proven itself to be a valuable tool for evaluating patients prior to in-person care and prescribing medication during post-operative evaluations.

Additional income

Teledentistry appointments are billable! Many insurance companies accept claim submissions for services rendered using telecommunication technology. Typically, CDT codes D9995 and D9996 are primarily used for these types of claims.

Obstacles of Teledentistry

Like we mentioned above, implementation of telemedicine has been slower in dentistry than other medical fields. Below, we cover the biggest obstacles for teledentistry adoption.

In-person care is often necessary

Some medical fields lend themselves better to telemedicine than others. For example, many mental health providers are able to effectively offer care through videoconferencing. Conversely, the most common dental procedures, ranging from teeth whitening to surgeries, rely on in-person care.

Additionally, the ability to implement teledentistry often depends on the type of treatment a dental practice provides. For example, orthodontic evaluations are much easier to do through videoconferencing than periodontal examinations.

Teledentistry implementation can be daunting

Using unfamiliar tech for video conferencing and sharing files can be overwhelming for many dental professionals. Additionally, many dentists are concerned with this teledentistry’s compliance with regulations. HIPAA-compliant telemedicine solutions, like Simplifeye, accelerate the implementation process, and make it easy to conduct remote dental appointments.

Bottom Line

COVID-19 accelerated the implementation of teledentistry in many dental practices nationwide. However, telemedicine adoption in dental practices has not kept up with other medical fields. The likely culprit is dentistry’s reliance on in-person care, which renders teledentistry useless for the common dental procedures.

However, teledentistry can be valuable for specific use cases. Teledentistry is an effective tool for evaluating patients remotely and prescribing medicine. Additionally, teledentistry adds an extra stream of revenue for dental practices. If you decide to implement teledentistry in your dental practice, there are several dental technology solutions, like NexHealth, that can accelerate implementation and management.

According to Kaiser Family Foundation, 37 million Americans do not have dental insurance. As a result, dental practices have begun offering their own personalized and affordable dental membership plans to patients. In total, less than 20% of dental practices currently have memberships. However, this figure is growing rapidly due to the adoption of dental membership plan software.

But how do these plans work? And are they a worthwhile investment for dental practices?

Dental practices should weigh the costs and benefits of membership plans and become familiar with the software tools that enable them.

Dental Membership Plan Overview

Dental membership plans are similar to other subscription-based services that you are familiar with, such as Netflix or Amazon Prime. Patients enroll in membership programs where they pay subscription fees on a monthly or yearly basis. In return, patients receive care at a discounted rate.

Typically, patients pay $20 to $30 per month for their membership plans. In return, they are eligible for two free cleanings per year, and receive 10-20% off additional services. By increasing loyalty and creating a new revenue line, membership plans can become lucrative for dental practices.

Dental Membership Plan Benefits

Dental membership plans offer a variety of benefits for dental practices and their patients. The most notable benefits are listed below.

Cuts out the insurance middleman

Both dentists and patients can agree that dealing with insurance companies is a hassle. Many dentists are frustrated with filing claims while insurance companies eat into their bottom line. For patients, dental insurance is expensive and restricts access to practices that are in-network. Dental membership plans remove insurance companies from the equation.

With the membership model, dentists dictate their own fee schedules, and receive payments directly from their patients. Dental practices end up making more money and are able to pass the savings along to their patients.

Attracts uninsured patients

Uninsured patients often don’t receive the care they need because they perceive dental care to be too expensive. Who could blame them? Insurance companies often have opaque pricing with high deductibles, premiums, and copays.

Dental membership programs have transparent pricing with discounted rates. Membership plans are far more attractive to uninsured patients and often lead to higher case acceptance rates.

Reduces time spent on claims

As we mentioned before, filing insurance claims steals precious time from you and your front-office staff. Maintaining high claim acceptance rates is difficult, and every dental professional is familiar with being on hold with insurance companies and dealing with rejected claims. Dental membership plans lift this burden from your practice, so you can focus on providing excellent care for your patients.

Dental Membership Plan Software

A barrier to offering dental membership plans is the notion that implementation is a time-consuming process. However, dental membership plan software allows dentists to quickly set up and efficiently maintain membership programs.

Dental membership plan solutions automate important processes and manage the membership programs on behalf of dental practices. This allows dentists and front-office staff to focus on more important tasks such as offering exceptional care for patients. The most important features found in dental membership plan software are listed below.

The most popular dental membership plan solutions are Kleer, Dental HQ, and illumitrac. In general, these solutions cost a few hundred dollars a month. The software is typically priced as a flat fee per location, or a few dollars per member per month.

Configurable dental membership plans

Solutions like Kleer allow practices to create custom care plans that fit their needs. Practices can set their own pricing and treatments to include in the plans. Practices can also offer discounts for groups and families.

Automatic payment collection

Dental membership plan solutions often include features that allow practices to automatically receive recurring payments from their patients. This reduces administrative workload and eliminates the need for front-office staff to chase down outstanding balances. This is likely the most important feature found in membership plan software from a financial perspective.

Analytics

Dental membership plan software typically also includes an analytics dashboard that tracks revenue and monitors your performance. Tracking key metrics helps increase memberships and promotes practice growth.

Bottom Line

Dental membership plans are gaining momentum in practices across the country. This movement is being catalyzed by dental membership plan software that makes it easier to implement and manage an in-house plan.

In general, starting a dental membership plan is a better idea for dental practices with a large uninsured population, or those looking for a new revenue stream. Practices with less than 250 patients are better off managing their in-house plans themselves. Larger practices with over 250 patients will likely benefit from using dental membership plan software, which costs a few hundred dollars per month.

In business, sometimes it’s hard to stand out from the crowd. You work hard, but so do a lot of your co-workers — and they are looking to get ahead just like you are.

Maybe an extra degree will push you over the top for that promotion.

According to U.S. News & World Report, the National Association of Colleges and Employers say that the average starting salary for Master of Business Administration (MBA) graduates is $79,043, more than $20,000 higher than those graduating with a bachelor’s degree in business. Those numbers go up with the prestige of the school they attend, U.S. News says, all the way up to averaging $173,860 annually with a degree from the top 12 universities in 2021.

And it’s not just the first year that salaries are higher for MBA grads. The returns multiply over time like any good investment.

Salary is not the only benefit of an MBA degree, U.S. News & World Report points out. Graduates make long-lasting relationships that can help them advance in their careers and get higher-paying positions. They can also learn skills that help them to become better managers and leaders in business and in their industries.

Even with the benefits, a 2018 GMAC survey showed MBA applications were down 7% in 2017. Young professionals might not be able to afford to quit work for two years to get the degree, or they may be hesitant to put in the after-hours work to earn their MBA.

Then there’s the cost — about $130,000 for the two-year degree at one of the top 10 U.S. universities, according to MBA Online. If they are out of work for two years, there’s also lost wages.

But a survey by Forbes magazine found that for MBA graduates in the top 50 schools usually paid off the cost of their degree within four years.

Of course, just getting into an MBA program is work. MBA programs look at college grades, work experience, Graduate Management Admission Test (GMAT) scores and a personal essay, where the applicant explains why they want an MBA. If they make it through all that, there will be an in-person interview.

Once the student gets in, they will spend the first two semesters on general management courses in accounting, finance, human and company performance, marketing, operations and strategy. The final two semesters will be spent specializing in one area.

Some people, especially the ones right out of college, are able to study full-time for their MBA while living and attending classes on campus. Others, especially older students, may have to study part-time for two to three years while taking classes after work.

An executive MBA — part-time study for people already in management positions — can be very expensive, but the manager’s company will often pick up part of the cost on for a good employee with even more leadership potential.

So, is the return on time and money worth it? That depends on what you want to do.

Someone planning to be a game warden, jeweler, childcare provider or dentist would do better to look at other advanced degrees.

People wanting to go into business, found a company or become managers are going to benefit the most from an MBA degree.

For those already in the business world, an MBA degree can help them climb the corporate ladder. People in business looking for a different path — into a different area of business — will also benefit from the skills they learn and connections they make while getting an MBA degree. The return on their investment should pay off in career advancement and salary for the rest of their career.

Fifty or so years ago, the owners of Listerine — the mouthwash with “the taste people hate twice a day” — claimed their magic but foul-tasting elixir could cure numerous maladies, including sore throats, the common cold, tooth decay and gum disease.

The Federal Trade Commission began putting an end to those false, unsubstantiated claims in 1978, when it ordered the company to spend $10 million on an ad campaign informing the public that, “Contrary to prior advertising, Listerine will not help prevent colds or sore throats or lessen their severity.”

So, the results of two recent peer-reviewed studies that found Listerine and an array of cosmetic and therapeutic mouthwashes kill the novel coronavirus in the laboratory should be approached cautiously.

The studies are in vitro, in glass, in the test tube, in the petri dish, and we won’t know if these compounds work on actual living organisms, in this case human beings, until in vivo studies are done.

Nevertheless, for dentists, dental hygienists and other dental healthcare providers, there’s plenty to celebrate in the studies, since they both validate some practices already put in place by dental offices when the pandemic took off in the United States last March and point the way forward for future research.

In July, The Journal of Infectious Diseases published a study by multiple authors, “Virucidal Efficacy of Different Oral Rinses Against Severe Acute Respiratory Syndrome Coronavirus 2.”

In September, The Journal of Medical Virology published “Lowering the transmission and spread of human coronavirus.” Both studies put cosmetic and therapeutic mouthwashes available over the counter and by prescription to the test.

The former study tested the effects of various mouthwashes on SARS-CoV-2. The latter study tested mouthwashes as well as several nasal rinses against human coronavirus, HCoV, which costs less to replicate than SARS CoV-2 and has a similar fatty, protective covering.

Cracking that fatty covering is what virucides do, and both studies suggest that the common household chemical hydrogen peroxide, H₂O₂, may be an effective virucide for eradicating novel coronavirus in oral cavities.

“The three products with H₂O₂ as their active ingredient all demonstrated similar abilities to inactivate HCoV,” the Journal of Medical Virology study found. “Crest Pro?Health decreased infectious virus by 99.9 percent to more than 99.99 percent; again, the contact times used made little difference.”

The contact times in the study were 30 seconds, 1 minute and 2 minutes. Theoretically, gargling with a diluted hydrogen peroxide solution for just 30 seconds may reduce novel coronavirus in the patient’s mouth and throat by 90% to 99.9%.

The American Dental Association concurs. Since the onset of the pandemic it has advised dentists to require patients “rinse with 1.5 percent hydrogen peroxide or commercially available rinses that contain 1.5 percent hydrogen peroxide just prior to beginning treatment.”

Lori Gordon Hendrick, MS, RDH, CDA, CDT and a dental office infection control consultant offered more details about hydrogen peroxide on the Registered Dental Hygienist website last March.

“The concentration of any rinse used should be at least 1.5 percent,” she wrote. “Patients should rinse for at least 1 minute. Over-the-counter peroxide is typically 3 percent; therefore, one should dilute 1-part hydrogen peroxide to 2-parts water. In the dental industry, we have several products [that contain H₂O₂]. Two examples are Colgate Peroxyl and Listerine Whitening Mouthrinse, both of which contain 1.5 percent peroxide. Also available is EverSmile which contains a 3.8 percent concentration of peroxide.”

Hendrick also endorsed oral rinses containing the active ingredient povidine-iodine, or PVP-I. Similarly, the study published by the Journal of Infectious Diseases found that a commercially available mouthwash containing PVP-1, Iso Betadine 1 Percent, was one of three products tested that “significantly reduced viral infectivity to undetectable levels.”

Somewhat unbelievably, given the dubious medical and dental claims made in its past, Listerine, the old-school nasty tasting stuff (not the brand’s numerous spinoff products), may be one of the most potent SARS-CoV-2 virucides on the market according to both studies.

“Listerine Antiseptic is an alcohol?based eucalyptol, menthol, methyl salicylate, and thymol formulation that historically has claimed numerous antimicrobial properties,” notes the Journal of Medical Virology study. “It currently lists only a claim to kill germs that cause bad breath. Our tests show that it is highly effective at inactivating HCoV in solution. Even at the lowest contact time of 30 seconds it inactivated greater than 99.99 percent of HCoV.”

Critics of this study have pointed out it used HCoV, human coronavirus, which isn’t a perfect stand-in for SARS-CoV-2. But the study published by the Journal of Infectious Diseases did use SARS-CoV-2 and expressed similar findings about Listerine.

“In agreement with our observation, different studies using Listerine observed antiviral activities specifically against enveloped viruses, implying an impact on the viral lipid envelope,” the study found. “The in vivo effects of the oral solutions require further analysis during clinical studies.”

The study concludes by noting that said in vivo experiments are already in the works.

Oral and naval cavity rinses — a 1% solution of Johnson and Johnson’s Baby Shampoo up the nose has proved effective at treating certain rhinoviruses — by definition are only a partial solution. Novel coronavirus thrives throughout the respiratory system and can hide in places medicine can’t yet reach.

In a story responding to the studies, The New York Times put it this way:

“Relying on mouthwash or a nasal rinse to rid the body of infectious virus would be about as futile as trimming the top of a cluster of weeds, paying the roots little mind, and expecting the garden pests to disappear.”

Still, both studies end on an upbeat note.

“Nasal rinses and mouthwashes, which directly treat the major sites of reception and transmission of HCoV, may provide an additional level of protection against the virus,” states the study published in The Journal of Medical Virology.

“While clinical trials will be necessary to confirm the virucidal potential of these products and assess their ability to limit transmission of HCoV within the general population, in the current manuscript we have demonstrated here that several commonly available healthcare products have significant virucidal properties with respect to HCoV.”

The study published in The Journal of Infectious Diseases, which did use SARS-CoV-2 in its experiments, ends with a forward-looking statement.

“Our findings clearly advocate the evaluation of selected formulations in clinical context to systematically evaluate the decontamination and tissue health of the oral cavity in patients and healthcare workers to potentially prevent virus transmission,” it states.

Let the experiments begin. In the dental setting, it seems likely that the SARS-CoV-2 viral load—the risk to workers in the dental workplace — has been lowered by requiring patients to rinse with hydrogen peroxide and povidine-iodine solution before dental procedures.

Like wearing proper personal protective gear and maintaining social distance, rinsing your oral and nasal cavities out with a virucidal solution may become yet another tool for stopping the spread of the pandemic.

Not that Listerine, now owned by Johnson and Johnson, dares make such a bold claim. On its COVID-19 FAQ page, it makes it plainly clear that the only thing Listerine Antiseptic can do is kill “99.9% of germs that cause bad breath, plaque and gingivitis.”

“Listerine mouthwash has not been tested against the coronavirus and is not intended to prevent or treat COVID-19,” the company continues. “Consumers should follow the preventive measures issued by the World Health Organization including washing hands frequently, maintaining social distance and avoid touching your eyes, nose and mouth.”

Sound advice.

Almost half of the nation’s dentists are back to work and open for “business as usual,” according to a recent survey by the American Dental Association. But when it comes to the supply chain for personal protective equipment necessary to provide full-service dentistry, business is anything but usual as the coronavirus pandemic lingers on.

According to the ADA’s ongoing survey, “COVID-19: Economic Impact on Dental Practices,” as of Sept. 7, just 60% of all dentists had a two-week supply of N-95/K-95 masks, which are now required when conducting all aerosol producing procedures, such as ultrasonic scaling, air polishing, and air abrasion.

A quarter of all dentists have a one-week supply of N-95/K-95 masks, and 11% have less than a week’s supply. The ratios are similar for surgical masks, face shields, gowns and disinfecting supplies.

The ADA national survey of 13,000 dentists is further broken down by type of practice: DSO, Non-DSO, Solo Dentists, 2 to 9 Dentists and Group (10+ Dentists).

This story refers to the aggregate numbers for all dentists unless otherwise noted, but there are some interesting variances between practices, including what appear to be higher shortages of PPE in larger dental organizations.

The current levels of PPE undoubtedly represent an improvement over the early months of the pandemic when 76% of all dentists were open for emergency services only and nearly 20 percent were closed outright. As practices began opening in May, it soon became apparent that the normal PPE supply chain had been severely disrupted by the pandemic.

In an interview in May with Patient Prism, Dr. Scott Drucker, DMD, president and co-founder of Supply Clinic, an online marketplace for medical and dental supplies including PPE, called the supply chain broken, especially in the case of masks.

“N-95s are extremely difficult to source right now,” Dr. Drucker said. “3M is shipping everything to hospitals and to governments, per FEMA’s directive. So, those aren’t on the market. There are some foreign-manufactured N95s that do come in little spurts, and we try to get those on the site (for order) when possible.”

The ADA estimates the demand for PPE is 10 times the supply. As Drucker notes, that demand has driven prices up 400 percent and higher. For example, a box of 50 surgical masks that cost $5 before the pandemic now costs $40 on the Supply Clinic website.

Who pays those inflated prices? Apparently not all third-party insurers are willing to foot the bill, which can be substantial considering the number of people required to wear protective gear, from dentists, to technicians to office staff to patients. The ADA has issued “COVID-19 Coding and Interim Guidance: PPE” to help guide dental health providers through the myriad changes in billing practices.

Just how broken is the PPE supply chain? An alarming article on the Journal of the American Medical Association’s Health Forum website, “Personal Protective Equipment Shortages During COVID-19: Supply Chain–Related Causes and Mitigation Strategies,” pulls no punches:

“The frightening reality is that the routine U.S. PPE supply chain was not designed with the primary objective of protecting health care professionals. Rather, it was designed to fulfill demand while focusing on efficiency and price. While this supply chain can fulfill normal demand, it cannot meet unexpected increases that occur during a public health crisis, such as the current COVID-19 outbreak or the 2009 influenza A outbreak.”

The authors, two MDs, Preeti Mehrotra and Preeti Malani, and an MBA, Prashant Yadav, explain that U.S. PPE production is limited, and 70% of our respiratory protection supplies come from China, which dramatically reduced production during its battle with coronavirus earlier this year. As a result, “Some health care systems currently face estimated delays of 3 to 6 months for requested supplies.”

Suddenly that two-week supply of N-95 masks doesn’t seem like quite enough.

Ideally, we should be able to turn to the Department of Health and Human Services’ Strategic National Stockpile and state stockpiles to complete the PPE supply chain. That’s what they’re supposed to be for — emergencies.

But that hasn’t worked, the authors claim, because the “overall stock in the SNS was much lower than previous estimates of what would be needed to protect health care personnel in the event of a severe influenza pandemic” and the “lack of transparency regarding PPE and other inventory in the SNS as well as the logic behind the allocation of its limited supplies has hampered credibility.”

The authors believe good old American ingenuity will help mitigate some supply chain issues. PPE sourcing initiatives such as ProjectN95.org have provided protective equipment to frontline healthcare workers battling the pandemic across the United States. The growling list of U.S. companies repurposing factories to manufacture PPE includes Ford, General Motors, Lacerta, 3M and others can be found at supplychaindive.com.

The increasing use of telemedicine has helped conserve PPE in the physician’s office, but dentistry ultimately involves treating patients in the seats. So how does the average dentist decide whether he has enough N-95 masks on hand? The Centers for Disease Control and Prevention publication “Strategies for Optimizing the Supply of PPE during Shortages” offers and excellent tool to do just that.

It’s called the PPE Burn Rate Calculator. It’s a simple database program with simple instructions:

“To use the calculator, enter the number of full boxes of each type of PPE in stock (gowns, gloves, surgical masks, respirators, and face shields, for example) and the total number of patients at your facility.”

As mentioned previously, according to the ADA survey, about 60% of all dentists have a two-week supply of N-95/K-95 masks on hand right now. They can use the burn rate calculator to determine whether that’s enough.

Last month, the World Health Organization recommended delaying “routine nonessential oral health care … until there has been a sufficient reduction in COVID-19 transmission rates from community transmission to cluster cases.”

The WHO was responding in part to the growing body of scientific evidence indicating novel coronavirus can be spread by respiratory droplets smaller than five microns in diameter known as droplet nuclei or, in more general terms, aerosols.

That’s concerning because aerosol-generating procedures are common in the dental workspace. According to the Centers for Disease Control, “Commonly used dental equipment known to create aerosols and airborne contamination include ultrasonic scaler, high-speed dental handpiece, air/water syringe, air polishing, and air abrasion.”

In a study published in May on the National Institutes of Health website and conducted by the School of Medicine at China’s Zhejiang University, “Possible aerosol transmission of COVID-19 and special precautions in dentistry,” researchers cited data demonstrating that aerosol generating procedures can transmit pathogens.

“When combined with bodily fluids in the oral cavity, such as blood and saliva, bioaerosols are created,” the study states. “These bioaerosols are commonly contaminated with bacteria, fungi, and viruses, and have the potential to float in the air for a considerable amount of time and be inhaled by the dentists or other patients.”

The study noted that so far, there have been “no reported cases of COVID-19 transmission in the dental setting.”

In the United States, that’s in part due to interim guidelines issued by the American Dental Association and the CDC that urged for the reduction of aerosol-generating procedures and initially called for delaying nonessential dental care, just as the WHO did last month.

But the ADA was quick to “respectfully yet strongly disagree” with the WHO’s call to delay “routine” care now, as many dental offices have successfully reopened.

“Millions of patients have safely visited their dentists in the past few months for the full range of dental services,” ADA President Chad P. Gehani said the day after the WHO’s announcement. “With appropriate PPE, dental care should continue to be delivered during global pandemics or other disaster situations.”

The WHO, ADA and CDC are more often in agreement than not when it comes to oral healthcare and COVID-19. The ADA and CDC have cautioned against using aerosol-generating procedures since May and are in a sense ahead of the curve.

“Current data do not support long range aerosol transmission of SARS-CoV-2, such as seen with measles or tuberculosis,” the CDC states. On the other hand, “Short-range inhalation of aerosols is a possibility for COVID-19, as with many respiratory pathogens.”

That’s especially true in the close confines of the oral healthcare setting, where many of the primary tools used generate bioaerosols. Indicative of the situation’s urgency, both the ADA and the CDC advise avoiding all aerosol generating procedures if possible, during the pandemic.

“Avoid aerosol generating procedures whenever possible, including the use of high-speed dental handpieces, air/water syringe, and ultrasonic scalers,” the CDC’s current guidelines state. “Prioritize minimally invasive/atraumatic restorative techniques (hand instruments only).”

If aerosol generating procedures can’t be avoided, the CDC recommends using “four-handed dentistry, high evacuation suction and dental dams to minimize droplet spatter and aerosols.”

As more evidence of COVID-19’s airborne potential has come in, the CDC has modified the interim guidelines. In late August, it issued new personal protection equipment recommendations for dental healthcare personnel in areas with no to minimal community transmission and areas with moderate to substantial community transmission.

Dental healthcare workers in areas with no to minimal community transmission are now advised to “wear a surgical mask, eye protection (goggles or a face shield that covers the front and sides of the face), a gown or protective clothing, and gloves during procedures likely to generate splashing or spattering of blood or other body fluids. Protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glasses and the face likely do not protect eyes from all splashes and sprays.”

Dental healthcare workers in areas of moderate to substantial community transmission are advised to take further precautions, especially if they’re performing aerosol generating procedures.

“During aerosol generating procedures DHCP should use an N95 respirator or a respirator that offers an equivalent or higher level of protection such as disposable filtering facepiece respirators, powered air-purifying respirators, or elastomeric respirators,” the new guidelines state.

The recommendation to wear an N95 respirator, its equivalent or better also applies to dental healthcare workers working with patients suspected or confirmed to have COVID-19.

“Airborne transmission from person-to-person over long distances is unlikely,” the new CDC regulations state. “However, COVID-19 is a new disease, and we are still learning about how the virus spreads and the severity of illness it causes. The virus has been shown to persist in aerosols for hours, and on some surfaces for days under laboratory conditions. SARS-CoV-2 can be spread by people who are not showing symptoms.”

Sometimes those people are patients, and both the CDC and the ADA advise dentists to check their patients for fever and other possible COVID-19 symptoms at the office door. Patients should be encouraged (but not forced) to wear at least a cloth mask to prevent spread of the virus. The CDC even recommends testing patients for coronavirus if quick test results are available.

The medical industry is changing quickly. While there have been major advances in the technological and biomedical engineering spaces, medical device manufacturers still need viable options for manufacturing devices and equipment both to patients and healthcare providers in an efficient, low-cost manner.

Moreover, the industry has an enormous need for customizable biocompatible and sterilizable components.

While many device manufacturers still use traditional production methods, 3D printing is making it possible to create biocompatible and sterilizable components at a pace that is equally fast as inexpensive.

Applications of 3D Printing in the Medical Field

3D printing has a number of novel applications that are making a big impact on the medical industry. These include:

3D Printed Prosthetics: Prosthetics need to be customized to meet the needs of each patient, making them both expensive and time-consuming to produce. Usually, the fitting process requires multiple castings and follow-up appointments to make sure they fit properly. With 3D printing, patients no longer need a physical cast. Using a scanner, data can be fed to a 3D printer that will develop a model that serves as the basis for a customized prosthetic in a single visit.

Patient Devices and Implants: Hearing aids, artificial joints, and heart valves have all been converting to 3D printing quickly. Hearing aids and heart valves can be produced in a single day when they used to take a week. Furthermore, silicone heart valves provide a major upgrade over traditional heart valves because the fit is more precise.

Dentistry and Orthodontics: Tools in the fields of dentistry and orthodontics require a high degree of customization as well. Dentures, crowns, implants, and retainers have to be tailored to meet the needs of the patient. Today, 3D scans and X-rays can be used to produce 3D printed models using sterilizable plastics in a short amount of time.

The Expansion of 3D Printing Materials

The materials used in 3D printing in the medical industry provide a major upgrade over traditional ingredients. Both TPU and Nylon have been rated by the FDA as Class I to VI for medical devices. This means they can handle prolonged skin contact without causing cytotoxicity. Some of the most popular materials used in 3D printing include:

• Nylon PA-12: This is a general-purpose plastic that is durable, light, and resists corrosion. It can be sterilized in a steam autoclave.
• Estane TPU: This is a 3D printable rubber for when applications call for an elastomer instead of rigid plastic.
• Titanium: Titanium is the leader when it comes to biocompatible metals. It is used for pacemakers, replacement joints, dental implants, and more.
• PC-ISO: This is a biocompatible polycarbonate that is used in FDM 3D printing. It is used in surgical guides and molds.

These materials make it possible for components produced via 3D printing to meet biocompatibility and sterilization requirements.

Benefits of 3D Printing in the Medical Industry

Manufacturing components for the medical industry requires precision to ensure compatibility, reliability and compliance. Turning to 3D printing as an option for producing components and parts offers the industry many benefits including:

• Cost reduction thanks to no tooling requirements
• The medical industry tends to be a low-volume space, which means that 3D printing makes this process much more affordable
• Customers can be flexible with their orders, allowing them to change their designs on short notice
• Shorter turnaround times than traditional methods

As the field of medicine advances and the need for highly customizable devices, components increase, 3D printing can offer the industry an option to produce these in a highly effective manner. With more options for making biocompatible, sterilizable and efficient components, the medical industry can advance in providing better patient outcomes.

The economy witnessed unexpected job growth in May as state and local economies began to reopen from the pandemic shutdown. In particular, medical practices and dental offices were key drivers of this finding that surprised economists.

According to the May 2020 Bureau of Labor Statistics (BLS) economic report, healthcare — including dentists — added more than 310,000 jobs during the month. Dental offices experienced job rebounds at rates unlike any in the sector.

The BLS says the healthcare sector grew to more than 15.2 million jobs. This represents a 2% rise, up from 14.9 million. Physician practices increased employment by at least 51,000 jobs compared to the previous report.

At the start of May, Grant Thornton, an independent audit, tax, and advisory firm,reported that posting for new jobs on all the major job websites fell between 30% and 40% in March and April. Some sites, they saw, a drop in posting as early as late February when the tech giants canceled off-site meetings and major conferences to stem contagion.

The halt spanned almost all industries across all income categories. Most notably, healthcare saw job losses, despite the health crises bought on by the pandemic. These losses were the result of the cancellation of all elective surgeries as health systems responded to COVID patients.

“The fear of going to dental and doctor’s offices and contracting COVID-19 prior to national lockdowns in March had already triggered the largest-ever drop in healthcare jobs in a single month,” Grant Thornton reported at the time.

An April 21 report in The Hill found that more than 4 in 10 polled Americans say they had their wages cut or lost their jobs altogether because of the pandemic. The Pew Research Center study found 28% of respondents lost their jobs or been laid off because of the outbreak. A third took pay cuts. A combined 43 percent said one or both applied to them.

As mentioned previously, dentist office employees were the biggest winners in the recent jobs report. Jobs increased here by at least 244,000, compared to April.

But hospital employment declined by 26,000 in May. Furloughs and firings continued for some health systems because of low patient volume and the cancellation of surgical procedures dating back to March. This is starting to change, however, as some hospitals are beginning to resume elective procedures.

Nursing care facilities also lost more than 36,000 jobs from April to May. As the Trump administration announced, the reason for this is that more than 32,000 nursing home residents have died because of COVID-19.

In May, the unemployment rate fell to 13.3%, after touching 14.7% in April. The total number of unemployed was 20.985 million.

April’s unemployment rate was the highest since the Great Depression. In 1933, the unemployment rate reached a record of 24.9%. Unemployment remained above 14% for nine years, from 1931 to 1940. April’s unemployment rate reached that level in just a month.

During the 2008 Great Recession, unemployment peaked at 10% in October 2009. In 1982, unemployment rose to 10.8%.

2020 has been a doozie so far, hasn’t it? And as the nation continues the process of recovery from all that has been dealt out so far this year, the American Dental Association is making plans to give one of its highest humanitarian awards next year.

Nominations for the 2021 ADA Humanitarian Award can be made through Sept. 15, 2020. This year’s focus will be on domestic service and will come with $10,000 to be given to the dental charity or project of the recipient’s choice. For 2021, the ADA Board of Trustees is modifying the award just a little to highlight volunteer participation in care programs within the U.S., with the change prioritizing sustainable dental health programs that benefit communities stateside, not anywhere in the world.

The ADA Humanitarian Award traditionally has recognized member dentists who have dedicated a minimum of 10 years to improving the oral health of underserved populations both stateside and/or overseas. This honor goes to someone who has contributed to alleviating human suffering and has exhibited notable leadership in the field of dentistry.

“The Humanitarian Award is one of the highest honors the Association bestows on an individual,” said Dr. Richard A. Stevenson, chair of the ADA Council on Advocacy for Access and Prevention. “Every year, the recipient’s actions continue to inspire the rest of us to fulfill the most meaningful aspirations of the profession by helping those who need care when so often it can be hard to be found.”

Criteria for Award Nomination

Dr. Stevenson looks forward to learning about all the dentists across the country who are making a difference every day. “Volunteerism often brings out the best of all of us,” he said.

Criteria for the 2021 ADA Humanitarian Award include:

• Demonstrate significant leadership and outstanding humanitarian volunteer accomplishments that bring honor to the profession of dentistry
• Contribution to alleviating human suffering and improving the quality of life and oral health of individuals in the U.S.
• Exhibit a commitment to humanity and selflessness without regard to direct personal or organizational gain or profit
• Serve as an inspiration to the dental profession, colleagues and patients
• Establish a legacy and/or sustainable program that has ongoing value and benefit to others

How to Nominate Someone for the ADA Humanitarian Award

Anyone may nominate any active, life or retired ADA member in good standing by submitting a nomination for consideration. The nomination does not have to come from a dental professional. Even patients can nominate someone! Any nominations received after the Sept. 15 deadline will be placed on file for consideration the following year.